Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Anaplastic Thyroid Carcinoma Workup

  • Author: Anastasios K Konstantakos, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
 
Updated: Apr 16, 2015
 

Laboratory Studies

See the list below:

  • Anaplastic thyroid carcinoma (ATC) cannot be definitively diagnosed with laboratory examinations of the blood or urine.
  • Obtain serum calcium levels to rule out medullary thyroid carcinoma or parathyroid neoplasms.
Next

Imaging Studies

See the list below:

  • Chest radiography may be used to determine the presence of lung metastases.
  • Preoperative cervical ultrasonography can detect lymph node metastases.
  • Cervical CT scanning can be used to define the local spread of disease. Detection of distant metastases to the mediastinum, liver, lung, bone, and brain is also possible via CT scanning or MRI.
  • Bone scanning can be used to determine the presence of bone metastases.
  • Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) can visualize primary tumors, lymph node metastases, lung metastases, and other distant metastases. [4]
Previous
Next

Procedures

See the list below:

  • Fine-needle aspiration often yields enough cytologic information to allow diagnosis; however, if the fine-needle aspiration does not provide definitive results, the patient may require an open surgical biopsy.
Previous
Next

Histologic Findings

Grossly, anaplastic carcinoma of the thyroid (ATC) is a large, fleshy, off-white tumor. Infiltration of adjacent structures can be observed grossly and microscopically. Histologically, the tumor may contain regions of spontaneous necrosis and hemorrhage. Typically, angioinvasion is detectable.

The main histologic variants include spindle cell, giant cell (osteoclastlike), squamoid, and paucicellular. The giant cell subtype typically exhibits local calcification with significant osteoid formation. The paucicellular subtype demonstrates rapid growth, intense fibrosis, focal infarction, diffuse calcification, and encroachment of adjacent vascular tissue by atypical spindle cells.

Thyroid lymphoma is the only curable condition that may be confused with ATC. Rule out lymphoma in the presence of a poorly differentiated large cell thyroid tumor. This investigation involves lymphoid tissue markers (eg, cytoplasmic immunoglobulin, immunoglobulin receptors, gene rearrangement studies).

Previous
Next

Staging

See Thyroid Cancer Staging for summarized information.

Previous
 
 
Contributor Information and Disclosures
Author

Anastasios K Konstantakos, MD Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Lodovico Balducci, MD Professor, Oncology Fellowship Director, Department of Internal Medicine, Division of Adult Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine

Lodovico Balducci, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American College of Physicians, American Geriatrics Society, American Society of Hematology, New York Academy of Sciences, American Society of Clinical Oncology, Southern Society for Clinical Investigation, International Society for Experimental Hematology, American Federation for Clinical Research, American Society of Breast Disease

Disclosure: Nothing to disclose.

Acknowledgements

Debra J Graham, MD, is gratefully acknowledged for the contributions made to this topic.

References
  1. Neff RL, Farrar WB, Kloos RT, Burman KD. Anaplastic thyroid cancer. Endocrinol Metab Clin North Am. 2008 Jun. 37(2):525-38, xi. [Medline].

  2. Smallridge RC, Marlow LA, Copland JA. Anaplastic thyroid cancer: molecular pathogenesis and emerging therapies. Endocr Relat Cancer. 2009 Mar. 16(1):17-44. [Medline]. [Full Text].

  3. Wong DD, Spagnolo DV, Bisceglia M, et al. Oncocytic adrenocortical neoplasms--a clinicopathologic study of 13 new cases emphasizing the importance of their recognition. Hum Pathol. 2011 Apr. 42(4):489-99. [Medline].

  4. Bogsrud TV, Karantanis D, Nathan MA, Mullan BP, Wiseman GA, Kasperbauer JL, et al. 18F-FDG PET in the management of patients with anaplastic thyroid carcinoma. Thyroid. 2008 Jul. 18(7):713-9. [Medline].

  5. Brignardello E, Palestini N, Felicetti F, Castiglione A, Piovesan A, Gallo M, et al. Early Surgery and Survival of Patients with Anaplastic Thyroid Carcinoma: Analysis of a Case Series Referred to a Single Institution Between 1999 and 2012. Thyroid. 2014 Sep 5. [Medline].

  6. Bhatia A, Rao A, Ang KK, Garden AS, Morrison WH, Rosenthal DI, et al. Anaplastic thyroid cancer: Clinical outcomes with conformal radiotherapy. Head Neck. 2009 Nov 2. [Medline].

  7. Noguchi H, Yamashita H, Murakami T, Hirai K, Noguchi Y, Maruta J, et al. Successful treatment of anaplastic thyroid carcinoma with a combination of oral valproic acid, chemotherapy, radiation and surgery. Endocr J. 2009 Apr. 56(2):245-9. [Medline].

  8. Swaak-Kragten AT, de Wilt JH, Schmitz PI, Bontenbal M, Levendag PC. Multimodality treatment for anaplastic thyroid carcinoma--treatment outcome in 75 patients. Radiother Oncol. 2009 Jul. 92(1):100-4. [Medline].

  9. Wiseman SM, Masoudi H, Niblock P, Turbin D, Rajput A, Hay J, et al. Anaplastic thyroid carcinoma: expression profile of targets for therapy offers new insights for disease treatment. Ann Surg Oncol. 2007 Feb. 14(2):719-29. [Medline].

  10. Wagle N, Grabiner BC, Van Allen EM, Amin-Mansour A, Taylor-Weiner A, Rosenberg M, et al. Response and acquired resistance to everolimus in anaplastic thyroid cancer. N Engl J Med. 2014 Oct 9. 371(15):1426-33. [Medline].

  11. Chiacchio S, Lorenzoni A, Boni G, Rubello D, Elisei R, Mariani G. Anaplastic thyroid cancer: prevalence, diagnosis and treatment. Minerva Endocrinol. 2008 Dec. 33(4):341-57. [Medline].

  12. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer. 2005 Apr 1. 103(7):1330-5. [Medline].

  13. Kim TY, Kim KW, Jung TS, Kim JM, Kim SW, Chung KW, et al. Prognostic factors for Korean patients with anaplastic thyroid carcinoma. Head Neck. 2007 Aug. 29(8):765-72. [Medline].

  14. Akaishi J, Sugino K, Kitagawa W, et al. Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma. Thyroid. 2011 Nov. 21(11):1183-9. [Medline].

  15. Orita Y, Sugitani I, Amemiya T, Fujimoto Y. Prospective application of our novel prognostic index in the treatment of anaplastic thyroid carcinoma. Surgery. 2011 Dec. 150(6):1212-9. [Medline].

  16. Ain KB. Anaplastic thyroid carcinoma: a therapeutic challenge. Semin Surg Oncol. 1999. 16:64-69. [Medline].

  17. Austin JR, el-Naggar AK, Goepfert H. Thyroid cancers. II. Medullary, anaplastic, lymphoma, sarcoma, squamous cell. Otolaryngol Clin North Am. 1996. 29:611-27. [Medline].

  18. Goutsouliak V, Hay JH. Anaplastic thyroid cancer in British Columbia 1985-1999: a population-based study. Clin Oncol (R Coll Radiol). 2005 Apr. 17(2):75-8. [Medline].

  19. Kapp DS, LiVolsi VA, Sanders MM. Anaplastic carcinoma following well-differentiated thyroid cancer: etiological considerations. Yale J Biol Med. 1982. 55:521-8.

  20. Schott M, Scherbaum WA. Immunotherapy and gene therapy of thyroid cancer. Minerva Endocrinol. 2004 Dec. 29(4):175-87. [Medline].

  21. Udelsman R, Lakatos E, Ladenson P. Optimal surgery for papillary thyroid carcinoma. World J Surg. 1996. 20:88-93. [Medline].

  22. Xing M. BRAF mutation in thyroid cancer. Endocr Relat Cancer. 2005 Jun. 12(2):245-62. [Medline].

 
Previous
Next
 
Algorithm for the management of a solitary thyroid nodule. FNAB = fine needle aspiration biopsy; US = ultrasonography.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.